Hi Reader,
Some weeks, everything flows. Patients show up on time, I’m present and calm, and the pieces of my practice click together smoothly.
This past week was… not one of those weeks.
I was busier than usual—not catastrophically so, but enough to throw off the rhythm I’ve been working to cultivate. Enough to leave me a little tense between patients, trying to fit just one more thing in, and feeling that creeping sense of being behind on paperwork, overdue on tasks, and stretched thin.
In weeks like this, I keep learning the same surprising truth: Sometimes, the most generous thing we can do for our patients is to put more structure in place, not less. Good structure does more than keep us organized. It creates a container where both practitioner and patient can feel held, safe, and ready to do the real work of healing.
The Paradox of Control
The most telling sign that my container is starting to crack? My charts stay open.
I use an AI tool (Heidi AI) to help me write chart notes—truly a game changer for freeing up my time and mental space. But when my schedule gets too full, even the simple act of pasting the note into my EHR, editing it, and clicking "sign" feels overwhelming. The notes pile up, waiting for a quieter moment that never seems to come.
It's a strange paradox: The more scattered I feel, the stronger my urge becomes to organize everything—to tighten up systems, clean my schedule, check off lingering tasks. Yet that's precisely when I have the least capacity to do so.
Why I Resisted Structure (and What Shifted)
Here's what kept me stuck for years: I thought being a "good practitioner" meant being endlessly flexible. After all, isn't that what my patients needed? I watched my peers bending their schedules, squeezing people in, working through lunch—and feeling just as overwhelmed as I was. I assumed this was simply the cost of doing healing work.
But something shifted when I started paying attention to the quality of care I could offer when I was depleted versus when I felt grounded. My patients weren't benefiting from my constant flexibility—they were getting a scattered, exhausted version of me instead of the present, engaged practitioner they deserved.
This landed differently than all my previous attempts at "boundaries." It wasn't about putting up walls—it was about creating a container strong enough to hold both my patients' needs and my own capacity to serve them well. I noticed, again and again, that when I let people book wherever they wanted or offered too many different appointment types, I wasn't actually providing better care. I was just more likely to drop the ball.
Simplifying to Reduce Decision Fatigue
One of the biggest shifts I've made is simplifying my appointment structure. I used to offer different lengths for follow-ups—thinking flexibility would help patients access care. But I found myself constantly discounting my own time and feeling resentful, or watching patients try to squeeze too much into shorter appointments (who could blame them?). Either way, I ended up rushed and scattered.
Now, all follow-ups are an hour. Sometimes we use the full time, sometimes less—but the space is there. Without the constant micro-decisions about session length or whether to extend time, my energy stays more stable. Both my patients and I can relax, knowing we have the container we need.
Creating Rhythms That Work
The same principle that led me to simplify appointment lengths helped me rethink my entire schedule. I used to let patients book on any quarter-hour, thinking this flexibility made care more accessible. But scattered appointment times meant scattered energy—sometimes a single appointment would fragment a two-hour block of my day.
Now my schedule has a clear rhythm: dedicated windows for new patients when I'm freshest, blocks for follow-ups that align with my natural energy patterns. This structure actually makes care more accessible because I can show up fully present, rather than constantly trying to reorient myself between scattered appointments.
(If you're curious about the practical side: I use Practice Better to maintain these scheduling boundaries. The right tools can make maintaining structure feel easy rather than rigid.)
Structure as a Gift
When I first started setting firmer boundaries around my schedule and time, I felt guilty. Wasn't I making things harder for my patients? Wasn't flexibility part of being caring and accessible?
But I've watched something remarkable happen: as my structures have become clearer, my patients have actually relaxed more deeply into their care. They know exactly what to expect. Their nervous systems can settle because the container is predictable and secure.
What I once saw as restrictions, I now see as gifts. Creating structure isn't about protecting myself from my patients—it's about protecting the space for both of us. When I'm not constantly managing time and energy, I can be fully present. My patients get a practitioner who's grounded and available, not scattered and depleted.
Like this past week reminded me, I don't always maintain these structures perfectly. But when things start to slip, I now recognize it as a signal to return to what works—not just for me, but for everyone I serve.
A Container for the Long Haul
Like any container, the structures I've built need regular tending. Healing work is inherently intimate and dynamic—there will always be moments that challenge our carefully crafted systems. But now when I feel scattered, I know it's not a sign to work harder or be more flexible. It's an invitation to return to what works.
If you're feeling the weight of constant flexibility in your own practice, consider:
- Where do you spend energy making repeated decisions that could be simplified?
- What's one small structure you could create to hold both you and your patients better?
I'd love to hear how you're thinking about the shape of your own healing container.
With care,
Katy
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